Geometry-Sensitive Protrusion Growth Directs Confined Cell Migration

The migratory dynamics of cells can be influenced by the complex microenvironment through which they move. It remains unclear how the motility machinery of confined cells responds and adapts to their microenvironment. Here, we propose a biophysical mechanism for a geometry-dependent coupling between cellular protrusions and the nucleus that leads to directed migration. We apply our model to geometry-guided cell migration to obtain insights into the origin of directed migration on asymmetric adhesive micropatterns and the polarization enhancement of cells observed under strong confinement. Remarkably, for cells that can choose between channels of different size, our model predicts an intricate dependence for cellular decision making as a function of the two channel widths, which we confirm experimentally.

Mobile and eHealth technologies in the management and prevention of nephrolithiasis: A systematic review

INTRODUCTION

Kidney stone disease (KSD) is a common urological condition that often requires long-term care. Mobile health (mHealth) and eHealth technologies have the potential to enhance chronic disease management and behavioral change. To assess opportunities to apply these tools to improve KSD treatment and prevention, we aimed to assess current evidence on the use, benefits, and limitations of mHealth and eHealth in KSD.

METHODS

We performed a systematic review of primary research studies of mHealth and eHealth in the evaluation and management of KSD. Two independent researchers screened citations by title and abstract for relevance, then full-text review was performed for descriptive summary of the studies.

RESULTS

A total of 37 articles were included for analysis. Primary domains of evidence included: 1) "smart" water bottles and mobile-device apps for tracking fluid consumption, which showed increased intake in most studies; 2) ureteral stent tracking platforms, which improved the rate of long-term retained stents; 3) virtual stone clinics, which have been suggested to increase access, lower costs, and have satisfactory outcomes; 4) smartphone-based endoscopy platforms, which offered cost-effective image quality in resource-limited settings; 5) patient information about KSD online, which was typically characterized as poor quality and/or accuracy, particularly on YouTube. Most studies were proof-of-concept or single-arm intervention designs, with limited assessment of effectiveness or long-term clinical outcomes.

CONCLUSIONS

Mobile and eHealth technologies have significant real-world applications to KSD prevention, intervention, and patient education. A lack of rigorous effectiveness studies currently limits evidence-based conclusions and incorporation in clinical guidelines.

cyjShiny: A cytoscape.js R Shiny Widget for network visualization and analysis

cyjShiny is an open-source R package that allows users to embed network visualization into Shiny apps and R Markdown documents. cyjShiny (https://github.com/cytoscape/cyjShiny) builds on the cytoscape.js Javascript graph library. Additionally, the package provides helper functions to convert common R data representations (e.g., data.frame) into forms compatible with cytoscape.js.

Measurement-based care training curriculum in psychiatry residency programs: I: Description of the curriculum and demonstration of implementation

BACKGROUND

Recent literature shows that most practicing psychiatrists do not receive training in measurement-based care (MBC). Among the primary barriers to MBC implementation are the lack of formal training and curriculums. We present the first comprehensive MBC curriculum for use in adult psychiatric practice, and describe how the curriculum is adapted and implemented in psychiatry residency training programs.

METHODS

The Standard for Clinicians' Interview in Psychiatry (SCIP) was developed as a measurement-based care tool for clinicians' use. The SCIP is the only instrument that includes 18 reliable and validated clinician-rated scales covering most adult psychiatric disorders. The SCIP has simple, unified rules of measurement that apply to the 18 scales. The MBC curriculum includes 2 instruction manuals, 4 didactic lectures, and 12 videotaped interviews. We describe the annual learning and implementation of MBC curriculum in residency programs.

RESULTS

The curriculum implementation at West Virginia University and Delaware Psychiatric Center began in 2019 and is ongoing. We present 3 case demonstrations of the implementation of MBC in clinical settings.

CONCLUSIONS

Comprehensive implementation of MBC curriculum in residency programs has the potential to facilitate research and create a "culture" of MBC in future generations of psychiatrists.

The impact of early flow and brain oxygen crisis on the outcome of patients with severe traumatic brain injury

BACKGROUND

Multimodality monitoring and goal-directed therapy may not prevent blood flow and brain oxygen (Flow/BrOx) crisis. We sought to determine the impact of these events on outcome in patients with severe traumatic brain injury (sTBI).

METHODS

Twenty-four patients with sTBI were treated to maintain intracranial pressure (ICP) less than or equal to 20 mm Hg, cerebral perfusion pressure (CPP) greater than or equal to 60 mm Hg, brain oxygen greater than or equal to 20 mm Hg, and near infrared spectroscopy greater than or equal to 60%. Flow/BrOx crisis events were recorded. The 14-day predicted mortality was compared with actual mortality.

RESULTS

Nonsurvivors had a significantly higher number of crisis events nonresponsive to treatment (P < .05). Mortality was 87.5% in patients with greater than or equal to 20 events versus 6.3% in patients with less than 20 events. The predicted mortality was 58%, whereas actual mortality was 33.3% (8/24), yielding a 42% reduction in mortality.

CONCLUSIONS

A multimodality monitoring and goal-directed therapy may decrease mortality in sTBI. However, Flow/BrOx crisis events still occur and predict a poor outcome.

Stem cell-based treatments for Type 1 diabetes mellitus: bone marrow, embryonic, hepatic, pancreatic and induced pluripotent stem cells

Type 1 diabetes mellitus--characterized by the permanent destruction of insulin-secreting β-cells--is responsive to cell-based treatments that replace lost β-cell populations. The current gold standard of pancreas transplantation provides only temporary independence from exogenous insulin and is fraught with complications, including increased mortality. Stem cells offer a number of theoretical advantages over current therapies. Our review will focus on the development of treatments involving tissue stem cells from bone marrow, liver and pancreatic cells, as well as the potential use of embryonic and induced pluripotent stem cells for Type 1 diabetes therapy. While the body of research involving stem cells is at once promising and inconsistent, bone marrow-derived mesenchymal stem cell transplantation seems to offer the most compelling evidence of efficacy. These cells have been demonstrated to increase endogenous insulin production, while partially mitigating the autoimmune destruction of newly formed β-cells. However, recently successful experiments involving induced pluripotent stem cells could quickly move them into the foreground of therapeutic research. We address the limitations encountered by present research and look toward the future of stem cell treatments for Type 1 diabetes.

Hepaticocholecystoduodenostomy compared with Roux-en-y choledochojejunostomy for decompression of the biliary tract

BACKGROUND AND OBJECTIVES

The nature of palliative decompressive surgery for unresectable periampullary tumor is usually determined by the experience of the surgeon. We compared hepaticocholecystoduodenostomy (HCD), a new palliative decompressive anastomotic technique, to Roux-en-y choledochojejunostomy (CDJ) in this prospective, randomized study.

PATIENTS AND METHODS

Twenty patients who were to undergo surgery for palliative bypass were randomized into two groups: group I was subjected to HCD (10 patients) and group II to CDJ (10 patients). Pre- and postoperative liver function tests, operative time, operative blood loss, onset of postoperative enteral feeding, length of hospital stay and survival rates were compared in the two groups.

RESULTS

Effective surgical decompression was observed clinically as well as on analysis of pre- and postoperative liver function tests in both the groups. The results were statistically significant in favor of patients in group I when compared to those of group II with respect to operative time 84.7 (10.3) min vs 133.6 (8.9) min; P =<.0001), operative blood loss 137.8 (37.2) mL vs 201.6 (23.4) mL; P =.001), postoperative enteral feeding 3.3 (0.5) days vs 5.0 (0.7) days; P =<.0001) and length of hospital stay 7.5 (0.7) days vs 9.7 (1.2) days ; P =<.0001). During follow-up, recurrent jaundice was observed in one patient in group I and two patients in group II, while duodenal obstruction developed in one patient in the group I series. Gastrointestinal hemorrhage occurred in one patient belonging to group II. The difference in mean survival time was not statistically significant.

CONCLUSION

Based on this small series, HCD seems to be a better palliative surgical procedure than the routinely performed CDJ.

Clinicopathological study of male breast carcinoma: 24 years of experience

BACKGROUND AND OBJECTIVES

Because breast cancer in men is rare, few patients are available for prospective studies. To learn more about its epidemiology, risk factors, clinical features, genetics and pathology in our country, we conducted a retrospective study of all cases seen in recent decades at our institution.

PATIENTS AND METHODS

We identified each case of male breast cancer in the database at the Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India, between the years 1983 to 2007.

RESULTS

We identified only 32 cases of male breast cancer over the 24-year period. Male breast cancer accounted for 32 (2.8%) of 1141 resected breast specimens, which included all breast lesions and 32 (4.1%) of 780 breast cancer cases. Of the 32 cases, 20 (62.5%) had various associated risk factors. Invasive ductal carcinoma was seen in 30 cases (93.7%). Of 20 cases that underwent molecular studies, 16 (80%) patients had estrogen receptor positivity whereas 14 (70%) had progesterone receptor positivity. Six cases (30%) overexpressed HER2 and p53. The BRCA2 mutation was observed in 4 cases (40%) while no patient presented with the BRCA1 mutation.

CONCLUSION

An incidence of 4.1% for male breast cancer indicates that this disease is not as uncommon as presumed in this part of the world. Breast cancer in men seems more frequently to be hormone receptor positive and the BRCA2 mutation confers a significant risk to men.

Coccygeoplasty: Treatment for Fractures of the Coccyx

Percutaneous vertebroplasty and sacroplasty are becoming common modalities of treatment for vertebral body compression fractures and sacral insufficiency fractures, respectively. The present report describes a case of a coccygeal fracture treated with injection of polymethylmethacrylate cement, which resulted in immediate relief of symptoms. It is suggested that this procedure be called coccygeoplasty.

Analysis of apical soft tissue margins during radical retropubic prostatectomy

PURPOSE

We determine the use of information gained with intraoperative biopsy and frozen section analysis of the apical soft tissue margin during nerve sparing radical retropubic prostatectomy.

MATERIALS AND METHODS

A separate 2 to 3 mm. circumferential biopsy was obtained from the apical soft tissue margin, and was sent for frozen and permanent section analysis during radical retropubic prostatectomy in 95 men with clinically localized adenocarcinoma of the prostate. A single pathologist examined the surgical and apical soft tissue margin specimens for evidence and extent of benign or malignant prostate tissue. Urinary continence was evaluated at catheter removal and 3 months postoperatively.

RESULTS

Of the patients 26% had positive surgical margins, of which 64% were positive apical margins. Permanent section of the apical soft tissue biopsy revealed no prostate in 39%, benign prostate in 54% and prostate cancer in 7% of patients. Because of the frozen section finding of adenocarcinoma in 3 patients, the apical soft tissue margin was further resected until the specimen was negative for malignancy. The apical soft tissue margin was the only positive margin site in 2 of these 3 patients. Positive surgical and apical margins, and percent tumor volumes greater than 26% on prostatectomy specimen had a significantly higher likelihood for positive apical soft tissue margins. The pathological finding of a positive apical margin on the surgical specimen had sensitivity, specificity, and positive and negative predictive values of 57%, 86%, 25% and 96%, respectively, for detecting prostate cancer on the apical soft tissue biopsy. Of the apical soft tissue biopsies 54% contained an element of benign prostatic tissue, although 92% of them contained benign tissue in less than 25% of the total specimen. Mean continence score in the men with and those without benign prostate tissue on apical soft tissue biopsy was 15.6 and 14.4, respectively (p = 0.15). The percent of men who required no protective pads for urinary continence at 3 months was 53% and 65% for those who had no prostate and those who had benign prostate tissue, respectively, in the apical soft tissue margin.

CONCLUSIONS

Excising and submitting an additional 2 to 3 mm. of apical soft tissue margin for permanent section analysis after prostate removal during radical prostatectomy represent an effective method for decreasing residual prostate tissue. Attempts at maximizing urethral length when dividing the prostato-urethral junction likely increases the chance of leaving residual prostate without improving continence.

The influence of out-of-plane geometry on the flow within a distal end-to-side anastomosis

This paper describes a computational and experimental investigation of flow in a proto-type model geometry of a fully occluded 45 deg distal end-to-side anastomosis. Previous investigations have considered a similar configuration where the centerlines of the bypass and host vessels lie within a plane, thereby producing a plane of symmetry within the flow. We have extended these investigations by deforming the bypass vessel out of the plane of symmetry, thereby breaking the symmetry of the flow and producing a nonplanar geometry. Experimental data were obtained using magnetic resonance imaging of flow within perspex models and computational data were obtained from simulations using a high-order spectral/hp element method. We found that the nonplanar three-dimensional flow notably alters the distribution of wall shear stress at the bed of the anastomosis, reducing the peak wall shear stress peak by approximately 10 percent when compared with the planar model. Furthermore, an increase in the absolute flux of velocity into the occluded region, proximal to the anastomosis, of 80 percent was observed in the nonplanar geometry when compared with the planar geometry.